Suzuki Masahiko, Arai Masaki, Hayashi Ayako, Ogino Mieko
Department of Neurology, The Jikei University Katsushika Medical Center, Tokyo, Japan.
Japan Medical Affairs, Takeda Pharmaceutical Company Limited, Tokyo, Japan.
eNeurologicalSci. 2020 Jul 16;20:100257. doi: 10.1016/j.ensci.2020.100257. eCollection 2020 Sep.
Parkinson's disease (PD) treatment should follow guidelines and be tailored to each patient. Large database analyses can provide insights into prescribing patterns.
Retrospective, cross-sectional study of patients (≥30 years) with PD diagnosis (ICD-10; schizophrenia/cerebrovascular disease excluded) using health insurance claims data (April 2008-December 2016) from the Japan Medical Data Vision database. Prescription patterns of anti-PD drugs were analysed by patient age and sex, calendar year, and overall.
The analysis comprised 155,493 PD patient-years (56.1% women, mean 73.4 years). Patient number increased each year, mainly because of database expansion. L-dopa as monotherapy was the most common prescription (22.7% of patient-years); non-ergot dopamine agonists (DAs) were also common (7.6% as monotherapy, 6.8% with L-dopa). Monotherapy was prescribed for ~50% of patient-years, two drugs for 14.1%, and at least three drugs for 18.4%. Consistent with Japanese guidelines, L-dopa was mostly prescribed to older patients (≥60 years), whereas non-ergot DAs were mostly prescribed to middle-aged patients (peak at 50-69 years). Between 2008 and 2011, L-dopa prescription decreased while that of non-ergot DAs increased; this pattern reversed between 2012 and 2016.
These results indicate that Japanese clinicians are adhering to Japanese guidelines and tailoring anti-PD treatment to individual patients.
帕金森病（PD）的治疗应遵循指南并根据每位患者的情况进行调整。大型数据库分析能够为处方模式提供见解。
利用日本医疗数据视觉数据库2008年4月至2016年12月的医疗保险理赔数据，对诊断为PD（国际疾病分类第十版；排除精神分裂症/脑血管疾病）的≥30岁患者进行回顾性横断面研究。根据患者年龄、性别、日历年及总体情况分析抗PD药物的处方模式。
分析涵盖155,493个PD患者年（女性占56.1%，平均年龄73.4岁）。患者数量逐年增加，主要原因是数据库扩充。左旋多巴单药治疗是最常见的处方（占患者年数的22.7%）；非麦角多巴胺激动剂（DAs）也很常见（单药治疗占7.6%，与左旋多巴联用占6.8%）。约50%的患者年采用单药治疗，14.1%采用两种药物治疗，18.4%采用至少三种药物治疗。与日本指南一致，左旋多巴大多开给老年患者（≥60岁），而非麦角多巴胺激动剂大多开给中年患者（峰值在50 - 69岁）。2008年至2011年期间，左旋多巴处方量下降而非麦角多巴胺激动剂处方量增加；2012年至2016年期间这种模式逆转。
这些结果表明，日本临床医生遵循日本指南并根据个体患者情况调整抗PD治疗。
